Consejo breve sobre el tabaco en atención primaria de salud en Chile: un desafío pendiente / Brief advice on tobacco in primary health care in Chile: a pending challenge

Introducción: El tabaco es la primera causa de morbimortalidad prevenible en el mundo. En Chile la prevalencia de consumo es 40,6 por ciento, la mayor a nivel continental. El consejo breve o consejería breve (CB) es una intervención simple, efectiva y de bajo costo para el cese de consumo de tabaco, que Atención Primaria en Salud (APS) ha demostrado disminuir en la prevalencia de tabaquismo. Existe escasa información sobre la utilización de CB en APS en Chile. Métodos: Estudio transversal de metodología cuantitativa. Se encuestó a 604 pacientes pertenecientes a 2 centros APS de Santiago, tras haber recibido atención clínica. Los datos fueron analizados con SPSS 21 y calculadora web Graph Pad. Resultados: La prevalencia de tabaquismo entre los encuestados fue de 32,5por ciento, de ellos, el 78,6 por ciento reportó deseo de dejar de fumar. Al 43,7 por ciento de los encuestados se le preguntó respecto al consumo de tabaco en la atención reciente, y del total de fumadores, a 37,1 por ciento se les aconsejó dejar de fumar. Los pacientes fumadores calificaron la recepción de CB como "indiferente", "agradable" o "muy agradable" en un 94,9 por ciento, y en un 90,5 por ciento, entre aquellos que no desean dejar de fumar. Conclusión: El tabaquismo es un problema escasamente abordado en las atenciones clínicas APS, lo que contrasta con la alta prevalencia de consumo nacional y de los pacientes consultantes. La mayoría de los fumadores desea dejar de fumar, y la minoría considera "desagradable" o "muy desagradable" ser aconsejada para cesar el consumo, aun en aquellos fumadores que no quieren dejar de fumar.(AU)

Introduction: Smoking is the leading cause of preventable morbidity and mortality worldwide. In Chile smoking prevalence is 40.6 percent, the highest on the continent. Brief advice or brief counseling (BC) is a simple, effective and inexpensive intervention for tobacco consumption cessation, that has been shown decrease smoking prevalence in Primary Health Care (PHC). There is little information on the use of BC in PHC in Chile. Methods: Cross-sectional study of quantitative methodology. 604 patients were surveyed from 2 PHC centers of Santiago, after receiving clinical care. Data was analyzed with SPSS 21 and Graph Pad web calculator. Results: The smoking prevalence among respondents was 32.5 percent, 78.6 percent of them expressed desire to quit 43.7 percent of respondents were asked about consumption of tobacco in a recent consultation, and a total 36.9 percent of smokers were advised to quit. Smokers patients rated reciving CB as "indifferent", "pleasant" or "very pleasant" in 94,9 percent and 90,5 percent among those who did not want to quit. Conclusion: Smoking is a problem rarely addressed in PHC, this contrasts with the high prevalence of domestic consumption and consulting patients. Most smokers want to quit and only a minority considered "unpleasant" or "very unpleasant" being advised to cease consumption, even in those smokers who do not want to quit.(AU)

Valor del autoreporte como método para estimar la prevalencia de factores de riesgo en prevención primaria: resultados del proyecto RICAR / Accuracy of the self report method for establishing the prevalence of cardiovascular risk factors in healthy adults: results of the RICAR project

Antecedentes: El autoreporte se ha utilizado frecuentemente como método para estudiar la prevalencia de los factores de riesgo cardiovascular (FRCV), por lo que es crucial conocer su grado de certeza. Objetivos: Determinar en una población de adultos aparentemente sanos la validez del autoreporte como método paraestimar la prevalencia de hipertensión arterial, hipercolesterolemia e hiperglicemia, comparando estos resultados con los obtenidos a través de la medición objetiva de estos parámetros. Método: En el proyecto RICAR, un total de 12.190 adultos sanos (6.320 mujeres, 5.870 hombres, edad 47,6 +/- 12 años) respondieron un cuestionario acerca de su presión arterial sistólica y diastólica (PAS, PAD), colesterol total (CT) y glicemia(GL). Conocían su PA 2.430, su CT 1.163 y su GL 1.556 personas. A ellos se les preguntó si los valores que estaban reportando eran normales o anormales, y se compararon estas apreciaciones con mediciones objetivas de estos parámetros. Resultados: Un 18,2 por ciento y un 15,6 por ciento refirió incorrectamente su PAS y su PAD como normales, mientras que el error fue de 44,9 por ciento y 15,8 por ciento respecto de CT y GL, respectivamente. Las mujeres tuvieron autoreportes de valores normales significativamente más precisos que los hombres para PAS, PAD y GL: 84,3 vs 77,6 por ciento, 88,7 vs 77 por ciento y 97,5 vs 94 por ciento respectivamente (p<0,0001), a pesar de tener un nivel educacional inferior a los hombres. El VP Positivo para el reporte de valores anormales de la PAS, PAD, CT y GL fue 54.3 por ciento, 46.7 por ciento, 75.1 por ciento y 41.8 por ciento respectivamente. El VP Negativo de los mismos parámetros fue 81.7 por ciento, 84.4 por ciento, 55.1 por ciento y 96.4 por ciento, respectivamente. La prevalencia verdadera versus la aparente en hipertensión sistólica fue de 30 vs 32,6 por ciento, hipertensión diastólica de 25,7 vs 32,6 por ciento y GL elevada de 10 vs 16,7 por ciento (índice de Kappa < 0.6)...

Background: Accuracy and validity of self reported data is a crucial aspect as massive populations´ surveys had become a common method of establishing population’s cardiovascular risk factors (CVRF) prevalence. Objective: To determine in a healthy adult population the accuracy of their self reported normal or abnormal values of Blood Pressure (BP), Total Cholesterol (TC) and Blood Sugar (BS), compared with clinical findings. Methods: A questionnaire about their own BP, TC and BS was answered by 12,190 healthy adults from the RICAR Project, (6320 women and 5870 men, mean age 47.6 +/- 12 y). Those who knew their parameters (BP n= 2,430, TC n= 1,163 and BS n = 1,556) were asked if they had normal or abnormal values. Using standardized methods we measured Systolic (SBP) and Diastolic Blood Pressure (DBP), Total Cholesterol and Blood Sugar (BS) and compare the referred data of normality/abnormality with clinical findings. Results: SBP and DBP were respectively uncorrectly reported as normal in 18,2 percent and 15,6 percent of the population. For TCand BS the mistaken reported normal values were 44,9 percent y 15,8 percent respectively. Women had significant more accurate selfreported normal values than men for SBP, DBP and BS: 84,3 vs 77,6 percent; 88,7 vs 77 percent y 97,5 vs 94 percent respectively (p<0,0001), eventhough they had a significant less educational level than men. Positive PV for abnormal SBP, DBP, TC and BS were 54.3 percent, 46.7 percent, 75.1 percent and 41.8 percent respectively. Negative PV for the same parameters were 81.7 percent, 84.4 percent, 55.1 percent and 96.4 percent respectively. True versus apparent prevalences evidenced differences with an overestimation of systolic hipertension 30 vs 32,6 percent, diastolic hipertension 25,7 vs 32,6 percent and high BS 10 vs 16,7 percent. Kappa index was low between these methods...

Prevensión cardiovascular y actitud de cambio frente a los factores de riesgo: un análisis crítico del estado actual / Cardiovascular prevention and attitude of people towards behavior changes: state of the art

In recent years the main focus of cardiovascular prevention has been to identify people without clinical evidence of coronary disease, but with a high risk of developing a clinical event. Long term follow up studies show that a young person with a high "Relative Risk" of presenting a cardiovascular event becomes an adult with a high "Absolute Risk" of suffering it. The aim of primary prevention is to avoid the appearance of cardiovascular diseases, delaying the development of atherosclerosis and its consequences. In this scenario, the first step is to increase awareness among healthy people of their own cardiovascular risk, enhancing their knowledge of their risk parameter values and generating a correct perception of the risk burden that those values mean. Literature review reveals that significant percentages of healthy individuals are unaware of their own values of blood pressure, total cholesterol and blood glucose. Furthermore, people aware of having abnormal parameters have low treatment compliance rates or evidence inconsistency between knowledge and behavior. This paper reviews educational strategies and other factors that influence this knowledge-behavior gap, such as the stages of behavior changes of the Prochaska and Diclemente Model. Evidence has shown that knowledge about cardiovascular risk factors is not enough to influence behavior and that the degree of preparation of people towards behavior changes is a strong predictor of the success of educational and counseling interventions. Local Chilean data from the RICAR project also shows that the profile of behavior change is different for each modifiable cardiovascular risk factor.

Pronóstico vital en insuficiencia hepática aguda grave: valor de los índices cuantitativos de evaluación / Life prognosis in severe acute hepatic failure: value of assessment quantitative index

The aim of this study was to assess the predictive value for mortality of admission and daily APACHE II score, mortality due to multiple organ failure and the organ failure score in patients with acute hepatic failure. We retrospectively studied 15 such patients admitted to an intensive care unit. Thirteen patients died (87 percent) and their admission APACHE II score was 22ñ7.5 compared to 21ñ8.5 in survovors. Daily APACHE II score, mortality due to multiple organ failure and multiple organ failure score had a 100 percent sensitivity to predict mortality and a 69.2, 76.9 and 76.9 percent specificity respectively. The predictive accuracies of multiple organ failure and multiple organ failure score were 80 percent and significantly better than the accuracy of admission APACHE II score (53 percent). We conclude that these prognostic scores can be useful in the assessment of patients with acute hepatic failure